Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008-2013: a retrospective cohort.

OBJECTIVE: This study utilized the Dr. Foster Global Comparators database to identify pregnancy complications and associated risk factors that led to severe maternal morbidity during delivery hospitalisations in large university hospitals based in the USA, Australia, and England. DESIGN: Retrospective cohort. SETTING: Births in the USA, England and Australia from 2008 to 2013. SAMPLE: Data from delivery hospitalisations between 2008 and 2013 were examined using the Dr. Foster Global Comparators database. METHODS: We identified delivery hospitalisations with life-threatening diagnoses or use of life-saving procedures, using algorithms for severe maternal morbidity from the Center for Disease Control. Frequency of severe maternal morbidity was calculated for each country. MAIN OUTCOME MEASURES: Multivariable analysis was used to examine the association between morbidity and socio-demographic and clinical characteristics within each country. Chi-square tests assessed differences in covariates between countries. RESULTS: From 2008 to 2013, there were 516 781 deliveries from a total of 18 hospitals: 24.5% from the USA, 57.0% from England and 18.4% from Australia. Overall severe maternal morbidity rate was 8.2 per 1000 deliveries: 15.6 in the USA, 5.0 in England, and 8.2 in Australia. The most common codes identifying severe morbidity included transfusion, disseminated intravascular coagulation, acute renal failure, cardiac events/procedures, ventilation, hysterectomy, and eclampsia. Advanced maternal age, hypertension, diabetes, and substance abuse were associated with severe maternal morbidity in all three countries. CONCLUSION: Rates of severe maternal morbidity differed by country. Identification of geographical, socio-demographic, and clinical differences can help target modifications of practice and potentially reduce severe maternal morbidity. TWEETABLE ABSTRACT: Rates of severe maternal morbidity vary, but risk factors associated with adverse outcomes are similar in developed countries.

Efficacy of topical acyclovir cream in first and recurrent episodes of genital herpes.

Fifty-three patients with first episodes and 60 patients with prior culture proven recurrent genital herpes were enrolled in a single centre, double-blind, placebo-controlled trial of 5% acyclovir in an aqueous cream base versus matching placebo. For first episodes treated with topical acyclovir the median duration of pain (4 vs. 8 days, P less than 0.05), time to healing of all lesions (8 vs. 14 days, P less than 0.001), duration of viral shedding (4 vs. 11 days, P = 0.001) and duration of new lesion formation (0 vs. 2.5 days, P less than 0.001) were reduced compared with placebo recipients. In patients with recurrent episodes who completed the study topical acyclovir significantly reduced the median duration of all symptoms (3 vs. 6 days, P less than 0.001), the time to healing of all lesions (4 vs. 6 days, P less than 0.01), and the formation of new lesions (5 vs. 29%, P less than 0.01) compared with the controls. Greater clinical benefits were demonstrated in females than in males, particularly for first episodes, but the number of males was small. Topical acyclovir cream is well tolerated and an effective treatment for first and recurrent episodes of genital herpes.

Experiments with active phase matching of parallel-amplified Multiline HF laser beams by a phase-locked Mach-Zehnder interferometer.

Active phase matching of multiline HF laser beams by means of a phase-locked Mach-Zehnder interferometer was demonstrated by locking the interferometer to the central interference fringe at zero optical path length difference. The central fringe could be found by varying the spectral content of the input beam. Laser amplification in one leg of the interferometer decreased fringe visibility without adversely affecting locking. Single-line fringe patterns produced by an array spectrometer (while the interferometer was operated in its scanning mode) were analyzed to show that no significant dispersion occurred in the amplifier. The techniques developed have potential for measuring dispersion mismatch between larger parallel amplifiers. These experiments demonstrated in principle that a number of multiline HF amplified beams can be recombined and phase-matched to produce a high beam quality output beam.

Annular (HSURIA) resonators: some experimental studies including polarization effects.

A repetitively pulsed CO(2) laser facility was developed for testing annular resonators. The large-aperture device exhibits generally uniform gain over an annular region of 18-cm o.d. and 10-cm i.d. The half-symmetric unstable resonator with internal axicon (HSURIA) was tested at equivalent Fresnel numbers up to 4.5. This resonator design incorporates a W-axicon mirror beam compactor that transforms a cylindricalmode region into an annular-mode region. Two HSURIA configurations were evaluated: (a) with a conical end mirror and (b) with a flat end mirror in the annular leg. With the conical end mirror, the aligned resonator produced a predominantly higher-order azimuthal mode with an on-axis null in the far field. The output was strongly linearly polarized with the electric-field vector tangential to the optic axis in both the near and far fields. The higher-order tangentially polarized mode appears to be the result of a geometric polarization scrambling effect caused by the conical end mirror. The boundary conitions for the conical or W-axicon mirrors imply that the radial electric field has a 180 degrees phase shift on reflection, whereas the tangential component is unchanged. Thus, a tangentially polarized mode is self-reproducing, but a linearly polarized mode is not. To eliminate the polarization scrambling effect in the HSURIA, the conical end mirror was replaced with a flat end mirror. The HSURIA with a flat end mirror produced a central spot in the far field that indicated an l = 0 mode with no spatial variations in polarization. Beam quality was measured in terms of the ratio n(2) of the theoretical (geometric-mode) power transmitted through an aperture of the central lobe diameter to the observed power; n(2) values as low as 1.2 were obtained. The variation of beam quality with tilt of the flat end mirror indicated a factor of 2 degradation in n(2) for a 20-microrad tilt, which is in good agreement with theory.

Prostitution in Sheffield.

Prostitution in Sheffield, a city with over half a million population, has been reviewed in its legal, social work, and medical aspects. The years studied were 1960-73. The medical studies were confined to the years 1968-72. Prosecutions for soliciting increased steadily during the study period. The trend was more marked locally than nationally and was associated both with increased police activity and, more recently, with the pursuit of a socially-aware sentencing, probationary, and social work policy. During the 5-year medical study, sixty prostitutes were seen. Using gonorrhoea as an index they were found to hazard the health of both themselves and others. Recurrent infection was the rule amongst them and 40 per cent. suffered salpingitis. In epidemiological terms our findings show that the vector role of prostitutes continues undiminished. The alleged decline in their role is relative only and not real. They accounted for one in six of locally acquired gonococcal infections in heterosexual men. The study indicates the need for the regular monitoring of the social phenomenon or prostitution and for the detailed study of all its aspects on a national basis.